Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kellie Kodama

Individual provider Physician Assistant · NPI 1164146494

Kellie Kodama is a Physician Assistant in Fullerton, California. Qualified in 2023, 3 years ago. Practices with Sunny Hills Medical Center Inc, a 4-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Arizona and California.

Years since qualifying
3
Licensed in
AZ, CA
In the registry since
2022
Specialties on file
2
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Practice location Address checks out

2575 Yorba Linda Blvd
Fullerton, CA 92831-1615
Phone: (714) 449-7400
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 7510 W Thomas Rd Ste 104, Phoenix, AZ 85033-5407 — (480) 677-8282

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X (CA)
Physician Assistant Taxonomy 363A00000X · Licence 11685 (AZ)

Record details

NPI number1164146494
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedSeptember 29, 2022
Last updated in NPPESJune 1, 2026
Certification dateJune 1, 2026
Mailing address261 N Roosevelt Ave, Chandler, AZ 85226-2617

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Sunny Hills Medical Center Inc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Fullerton